In addition to being an accomplished professor and ophthalmic plastic and reconstructive surgeon, American Board of Ophthalmology Examiner Tamara Fountain, MD, is the proud daughter of a former United States Air Force aviation instructor and retired commercial airline pilot. In a recent piece for Harvard Medicine Magazine, Dr. Fountain fondly recalls childhood moments spent with her father, Woody, learning about everything from aerodynamics to air traffic control – and how his insights about situational awareness in flying ultimately taught her important lessons about being a physician.
As Dr. Fountain explains:
Over the years, I’ve come to recognize a number of parallels between medicine and aviation: They are both highly regulated institutions in which the barriers to entry are high. Both require long training periods. And, for both, the cost of failure is great.
But it’s understanding how those failures occur that is what’s most interesting to both Dr. Fountain and her aviation expert father.
My dad identifies what can be a common theme in airplane crashes—the pilots, he says, actually “forget to fly the airplane.” A relatively minor distraction triggers a fatal cascade of events. The pilots lose situational awareness and, during the ensuing calamities, forget to ask three basic questions: Where am I? How fast am I going? In what direction am I headed?
Those three questions led me to think about how physicians fail to properly diagnose patients. The diagnoses we miss most often are common ailments, not exotic “zebras.” In my field of ophthalmology, among the top diagnoses we miss are glaucoma, retinal detachment, and intraocular infection. A first-year resident would easily recognize all three. Yet, like the pilots of that ill-fated Air France flight, physicians who fail to connect the dots and recognize what should be obvious commit the medical equivalent of forgetting to fly the airplane. We physicians lose clinical situational awareness and, as a consequence, forget to treat the patient.
To continue reading Dr. Fountain’s exploration of clinical situational awareness and the future of patient safety in medicine, click here.
Pictured: In the above photo from 1985, Dr. Tamara Fountain joins her father, Woody, in the cockpit of an airplane.